[mdenriquez]

I have received a summons filed with the Superior Court of CA from a collection agency - Cause of Action (common counts - breach of contract) against hospitalists which provided unauthorized services to my late husband in late October-November 2008. The hospitalists were not contracted with my husband's medical insurance so insurance covered only 70-75% of the bill and the remaining balance CA says I am responsible to pay. I was asking for the contract or authorization that my husband signed but they say that it is automatic once you're admitted at the hospital. I don't know about hospital procedures, etc. - can anybody tell me if this is standard with hospitals?

[Fr_Chuck]

There would have been ( expect if he was sent to ER directly and unable to sign) been admission paper work. It is always the patient ( except in life threatening injuries) to be sure the hospital is covered under their plan. It is not the hospitals duty. The patient is liable for the full amount of the treatment if the insurance does not pay.

He can get ( not you) unless he died and you are over the estate, copies of the admission paper work. And copies of any discharge paper work.

What you are bound by is the insurance agreement.

[mdenriquez]

There would have been ( expect if he was sent to ER directly and unable to sign) been admission paper work. It is always the patient ( except in life threatening injuries) to be sure the hospital is covered under their plan. It is not the hospitals duty. The patient is liable for the full amount of the treatment if the insurance does not pay.

he can get ( not you) unless he died and you are over the estate, copies of the admission paper work. And copies of any discharge paper work.

What you are bound by is the insurance agreement.

Thank you Fr_Chuck. Contacted insurance but was told that since the outside hospitalists, not the hospital itself, were not contracted with the insurance, they should have requested for preauthorization before any procedure were to be done. The primary care physician as well as the other doctors, etc. directly assigned to his case and provided their services had my husband sign an authorization and/or consent form. My husband passed away and I am faced with this lawsuit and damaged credit rating.

[JudyKayTee]

Then that's your legal argument - the hospital was aware that whatever services were not covered had to be preapproved and the hospital neither got a consent nor got a pre-approval. Of course, if it's a life and death situation, then they did what they could to save your husband's life and they had a far less standard to meet.

My late husband also had emergency services which were not preapproved and our health insurance covered NONE of those charges, not a percentage. My company either paid or didn't paid, nothing in between. In my case I appealed the insurance company's decision on the grounds that this was emergency treatment and there was no time and the insurance company DID cover the services.

Have you tried that (an appeal)?